This article was originally posted on Medium.
Emily Bensen, Deputy Director of Integrate Health, joined Chief Strategy Officer, Kevin Fiori in Togo to promote continuous learning efforts. This is her firsthand account of what creating an organization-wide culture of continuous learning looks like.
I recently had the chance to visit our team in Togo with our US-based Chief Strategy Officer, Kevin Fiori. Our mission was to strengthen Integrate Health’s organization-wide culture of continuous learning.
Kevin and I landed in the capital city of Lomé on a sunny Saturday afternoon. The next day, we met up with our Chief Partnerships Officer, Andrew Lopez, and made the six-hour journey by car up the national highway from Lomé to Kara, where Integrate Health is headquartered. When we finally arrived at the office, we were met with an orchestrated frenzy. We were about three weeks away from the Integrated Primary Care program launching five new health centers in the Bassar District. This area, which served a population of 40,000, would effectively double the impact of the organization by doubling the number of women and children who have access to high-quality primary care. Great news, but double the health centers, double the Community Health Workers, and double the patients means double the data — to collect, organize, store, and most importantly, to use effectively.
Kevin and I were joining the team in person to help them think through how our Monitoring, Evaluation, and Quality Improvement process will adapt to this new workload.
Kevin started the first morning of our workshop with the Monitoring, Evaluation, and Quality Improvement (MEQI) team with a question: “Why do we collect data?”
He started by throwing a few ideas out himself onto the flip chart paper:
– to complete donor reports
– to keep a paper trail
Eventually, opening it up to the rest of the team. Many of my colleagues answered in unison: “to improve care for our patients.”
Kevin jokingly responded, “My work here is done.”
Integrate Health’s data philosophy really is as simple as that: we collect data to improve care for our patients. We ask questions about how we’re doing, collect data that will answer those questions, and analyze it to identify ways we can improve. We do not collect data or perform research just for the sake of it; instead, we collect data with the goal of understanding why and how our programs work. We believe there is always room to do better.
The fancy word for this approach is called “Implementation Science,” defined as the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. The simple definition is: asking questions, then using the answers to improve care for our patients, creating a culture of continuous learning.
Back at the workshop, once we identified that the goal of our MEQI team is to improve care for patients, we dove into how to operationalize this mission. We created a simple “Data Pyramid”, with the base being quality improvement data collected on a weekly basis, and the top point being system evaluation data collected every two or three years. We identified each type of data we collect, from where, and at what frequency. The pyramid diagram allowed us to see how they all fit together into a comprehensive MEQI strategy, allowing us to achieve our mission of saving lives. Next, we went around the table team member by a team member, updating job descriptions to reflect where they intervene in the data pyramid. For example, Agnès, Coordinator of Community Evaluations, contributes to data collection in the annual program evaluation phase, as well as in the weekly quality improvement phase. Modestine, MEQI Assistant, enters data from paper forms into digital forms across the pyramid. This very detailed and tangible activity encouraged each team member to see the direct link between the work they do every day, to the overall mission of the organization. The way we see it, every person in the organization, whether it’s an executive assistant, Community Health Worker, or Country Director all have a role in improvement.
This ethos of “continuous investigation” and relentless improvement already exist at Integrate Health; Kevin and I were only reviving them in preparation for the launch of Phase II. In fact, on this same trip, I witnessed first hand our culture of continuous learning in action.
A month prior, the MEQI team noticed a dip in prenatal care coverage or the number of women who receive the recommended four prenatal consultations before delivering at a health center. With the spirit of striving to always do better by our patients, hey set out to figure out why. They started by digging into the data and discovered that one site had much lower rates of prenatal coverage than others. They then connected with the programs team, who went out to the particular site and discussed the dip in prenatal coverage with Community Health Workers (CHWs) and midwives, to dig further. As it turns out, CHWs were able to identify two remote villages where they have an especially difficult time effectively referring women to the health center. The CHW Supervisor accompanied the CHW who serves those villages out to meet with the community there. After speaking with village chiefs and women themselves, the problem of distance to the clinic surfaced as the primary barrier to women attending prenatal consultations in that community. The IH programs team and the health center staff devised plan to address this barrier: the midwife accompanied by a CHW will travel to the two villages once a month to perform prenatal consultations remotely. The team set out to put this system in place. In a month, they’ll come back together to see how it is being implemented and watch for a change in prenatal coverage.
Integrate Health’s culture of continuous learning is a cycle of improvement that never ends. We approach our programs with the belief that there is ALWAYS room for improvement. We can always do better for our patients. Our goal is to facilitate this environment of improvement, to make it the default and the expectation because our patients deserve it.